Ammon Bundy won’t respond to lawsuit, so St. Luke’s Health System takes more legal action

Ammon Bundy and associate Diego Rodriguez are not following legal processes in a lawsuit that stems from a child protection case, according to new court filings.

Bundy ignored a court order, and Rodriguez is nowhere to be found, according to motions and affidavits filed this month by St. Luke’s Health System and its fellow plaintiffs — St. Luke’s CEO Chris Roth, the health system’s Boise hospital, and two health care providers.

The lawsuit filed in May accused the men and their closely linked political organizations — People’s Rights Network and Freedom Man PAC — of defamation and harassment.

Rodriguez’s grandson was hospitalized in March at St. Luke’s with severe malnourishment, and was taken into child protection.

Idaho extremists target judges, prosecutors, health workers in doxxing campaigns

Rodriguez, Bundy and their followers urged people to protests at St. Luke’s, doxxed health care providers associated with the boy’s medical care and, according to the lawsuit, disrupted operations at the Boise hospital.

The hospital at one point went on lockdown for an hour and was unable to accept patients in ambulances.

Bundy, Rodriguez and their organizations launched “a knowingly dishonest and baseless smear campaign,” the lawsuit said. The men made false claims, including that St. Luke’s “engaged in widespread kidnapping, trafficking, and killing of Idaho children.”

St. Luke’s on Friday asked an Ada County court to impose sanctions on Bundy because he refuses to respond to the lawsuit or provide information, “despite acknowledging to the public that he is aware of the lawsuit and stating in interviews that he plans to ‘expose’ the hospital,” one of the documents said.

Bundy “continues to make false and defamatory statements” and refuses to comply with court orders to hand over documents, St. Luke’s argued.

Indeed, court files show nothing submitted by Bundy or Rodriguez in their defense. There is no record of Bundy following the court’s order to give St. Luke’s documents they could use as evidence. (Bundy and Rodriguez can also demand documents from St. Luke’s but don’t appear to have made an attempt as of Tuesday.)

The attorney for St. Luke’s had requested documentation about Bundy’s People’s Rights Network and Rodriguez’s Freedom Man PAC, including: who manages or holds ownership interest in their websites; the legal structure and people in charge of both organizations; and the identities of people who wrote or posted the allegedly defamatory statements. They had until June 17 to respond.

The health system and its fellow plaintiffs asked the judge to impose sanctions on Bundy for flouting his legal obligations.

Instead of responding to the lawsuit in court, Bundy has spoken about it while campaigning for governor. He said in an interview that the lawsuit is “an opportunity to further expose (the hospital and other plaintiffs) because they are pretty wicked,” the motion said.

They asked the judge to order Bundy to sit for a deposition where he would have to respond to their questions about the website and who controls People’s Rights Network, and to order him to pay the costs of the deposition.

“Bundy has demonstrated a pattern of ignoring court orders,” it said, citing the jail sentence Bundy received after trying to claim hours he spent on his gubernatorial campaign as community service, against a judge’s instructions.

That history “demonstrates that lesser sanctions than requested would not be effective,” the motion said. Bundy’s “obstructionist and deceptive behaviors (have caused St. Luke’s) to waste time and money,” it said.

“Because Bundy’s actions demonstrate an indifference to the judicial process and a disregard for the harm he is causing others, and because Bundy’s failure to obey the court’s order is not substantially justified … (St. Luke’s and its fellow plaintiffs) are entitled to their reasonable expenses, including attorney fees,” the motion for sanctions said.

According to Idaho’s rules for civil lawsuits, the judge could consider Bundy’s conduct to be contempt of court, could skip the trial process and simply rule in favor of St. Luke’s and the other plaintiffs, or could impose other kinds of sanctions.

Bundy was served with the lawsuit on May 12. But Rodriguez has managed to avoid being formally served with the lawsuit since mid-May.

The person hired to find and deliver the lawsuit and summons tried to serve Rodriguez at three different addresses over a two-day period. At each address, a person opened the door but said they didn’t know Rodriguez, or a neighbor said they didn’t know “if anyone lived in that apartment,” the summons record said. The server went to one of Bundy’s campaign events in Meridian a week later, on May 21, but couldn’t find Rodriguez there, either.

Finally, he sent the summons by certified mail to addresses in Boise and Orlando, Florida.

Earlier this month, the attorney for St. Luke’s asked to have Rodriguez served via publication in a newspaper.

“It appears that Mr. Rodriguez may no longer reside in Idaho,” Holland & Hart attorney Erik F. Stidham wrote in an affidavit.

“Further, I have learned that there appears to be a significant tax lien against Mr. Rodriguez put in place by the State of Idaho,” Stidham wrote. “The existence of the tax lien creates concern that Mr. Rodriguez has left the state to avoid legal proceedings in the State of Idaho.”

The Idaho State Tax Commission filed a lien in November against Rodriguez for $138,392 of unpaid taxes, according to a search of tax liens by the Idaho Capital Sun.

The affidavit notes that Rodriguez publicly commented on the lawsuit and, after reading it, continued to make allegations similar to those described in the St. Luke’s complaint.

“Despite being aware of the lawsuit, Mr. Rodriguez has made no effort to contact me or my firm,” Stidham wrote.

A hearing is scheduled for July 12 in Ada County on the motions to sanction Bundy, and to serve Rodriguez with the lawsuit by publishing a notice in a newspaper.

Idaho Capital Sun is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christina Lords for questions: Follow Idaho Capital Sun on Facebook and Twitter.

Are monoclonal antibodies here? Yes, but not everyone can get them

Before he was vaccinated against COVID-19, former President Donald Trump caught the coronavirus and became one of the earliest patients to receive an infusion of the antibody cocktail made by Regeneron Pharmaceuticals. He raved about the medication and promised it would be available to the public.
Today, it is. But as more unvaccinated people came down with COVID-19 in recent months, demand spiked for monoclonal antibody medications like Regeneron's. The federal government this month announced it would start to allocate them for distribution through each state, similar to the COVID-19 vaccine rollout.

Monoclonal antibody therapeutics are authorized by the Food and Drug Administration — the same kind of authorization the FDA gave to Moderna and Johnson & Johnson COVID-19 vaccines. The monoclonal antibodies are not yet FDA-approved like the Pfizer vaccine is.

Idaho health officials are working to make the drug available to people at greatest risk of hospitalization. However, they warn: monoclonal antibodies are no substitute for a vaccine. The drugs cannot prevent illness, they're not as effective as COVID-19 vaccination at keeping people out of the hospital, and they're not abundantly available like the vaccines are.

We are doing what we can to make these life-saving treatments widely available, but Idahoans are urged to choose to receive the vaccine to protect themselves and ensure health care access is available to all.

– Idaho Gov. Brad Little, in a Sept. 29, 2021, news release about monoclonal antibody treatment centers

Not everyone can take them, either. They must be given shortly after infectiononly to people at risk of being hospitalized, before they need to be hospitalized.

They're also far more costly than the COVID-19 vaccine. Treatments and vaccines are provided at no cost to the patient. But the U.S. government agreed to pay $2,100 per dose for the antibody treatments, according to a Regeneron news release. That's about 80 times the reported price for a dose of vaccine, which also takes less time, space and work to administer than the infusions.

Idahoans with COVID-19 have received thousands of courses of these treatments since December 2020, according to federal data. Their use began slowly in Idaho, with dozens of infusions or injections given each week, then ebbing and flowing.

About a month ago, they took off, and the number rose to hundreds of doses per week.

Idaho pledged $1.8 million to make treatments more accessible

Gov. Brad Little last month announced plans to stand up three state-sponsored treatment centers, in addition to the dozens of hospitals, clinics and infusion centers already giving them to Idaho patients. Two of the new, state-sponsored centers have opened in East Idaho, through Mountain View Hospital in Idaho Falls, and in North Idaho.

A total of $1.8 million in state funds was set aside for the state-sponsored sites, according to the governor's office. The state has awarded the two existing sites $600,000 each, to help cover the costs of staffing, equipment, space and supplies.

The state-sponsored monoclonal antibody centers are expected to serve eligible COVID-19 patients from the community in general, not just patients of a certain hospital or clinic, the governor's office said.

“Monoclonal antibody treatments are one more tool in our toolbox to save lives and reduce hospitalizations," Little said in a news release Wednesday after touring the North Idaho site, operated by Heritage Health and Northwest Specialty Hospital at the Coeur d'Alene Fairgrounds.

The surge in demand, and subsequent need to mete out the supply, came just as Idaho was preparing a state-sponsored monoclonal antibody center for the Treasure Valley. To ensure that existing sites have enough supply, state officials paused work on the Treasure Valley center.

Health care providers in southern and southwestern Idaho still have multiple places to send patients. St. Luke's Health System, for example, has infusion sites from the Magic Valley to Fruitland.

“I would remind everybody that, because of what COVID is doing nationwide, there's a supply crunch," said Idaho Gov. Brad Little on a telephone town hall Tuesday. “And it's a lot easier to get vaccinated, to talk to your doctor and make the choice to get vaccinated, than to wait and take the chance that there may not be monoclonal antibodies (available). As a reminder, the Pfizer vaccine has got full approval, but the monoclonal antibody is still under an emergency use authorization. … We're putting resources into it, but it's not as good as the vaccines."

What are monoclonal antibodies?

The drug REGEN-COV (casirivimab/imdevimab) is “by far the most common to be used," said Dr. Laura McGeorge, an internal medicine physician at St. Luke's Health System and director of the health system's COVID-19 Recovery Clinic.

“When someone gets COVID-19, it takes a little time for their antibodies to kick in, so this is a way that we can kind of synthetically add more antibodies to help reduce the likelihood of their ending up in the hospital," McGeorge said.

So far, the drug remains effective against the delta variant, but that could change. Every time the coronavirus replicates in the human body, it can mutate in a way that makes it easier for the virus to evade the synthetic antibodies.

Where and how do Idahoans get these drugs?

The infusions and injections are available through about 30 health care organizations in the state.

Health and Welfare Director Dave Jeppesen said Tuesday that while the treatments are free for the patient, not everyone can get them.

To be eligible, a person must:

  • Test positive for COVID-19, using a PCR test.
  • Have risk factors for hospitalization, such as older age, obesity or high-risk chronic health conditions.
  • Be early in their course of illness. The drugs only work if they're given within 10 days of the first COVID-19 symptoms.

“So if you think you're a candidate, you need to talk to your doctor immediately after getting a positive test," Jeppesen said.

McGeorge told the Sun that treatment should begin early, “the sooner the better."

But people cannot walk into a center or a hospital to get the treatments. They have to be referred by a doctor or other health care provider, after their positive test and after evaluation of risk factors — but before the 10-day window has passed.

“You cannot self-refer as a patient," McGeorge said.

She urged patients who test positive for COVID-19 and are referred for monoclonal antibody treatments to answer their phones. The infusion schedulers say patients aren't answering their calls or checking for messages and risk missing out on a potentially life-saving medication, she said.

To keep nurses at the bedside, St. Luke's deployed pharmacists to do infusions

St. Luke's began offering the medications to patients as soon as they became available to order, said Scott Milner, St. Luke's senior pharmacy director.

“Everywhere we have a footprint, we've been doing infusions," he said.

The infusions are a challenge, though, especially during a health care crisis. The drugs require a nurse or other qualified health professional to administer. They take time — time for the infusion, plus a long observation period after the infusion. And COVID-19 patients cannot mix with other patients, so the infusion sites must be in their own, isolated space.

As they went into Labor Day weekend and cases surged, the health system realized it needed to ramp up capacity to treat Idahoans, Milner said.

So, they came up with a plan. They found space, and tapped pharmacists to help administer the drugs. The pharmacists now work long shifts, in heavy PPE, but they've managed to treat dozens of patients a day. They opened a clinic in Meridian that “has really been key," Milner said.

St. Luke's went from administering about 60 treatments a week, to treating about 50 patients on a recent Wednesday.

“We feel that this therapy is doing a great service to the community," Milner said. “This is a lifeline. We unfortunately have a limited resource of not only the medication but also the chairs in which to administer it. And so, we are working with our providers to make sure that we are … prioritizing this for the patients that are really at most risk (of hospitalization or death) and making sure we get them in as early" as possible.

That short supply has caused concern.

Ada County Commissioner Rod Beck recently called a meeting to try to find ways for the county to help facilitate a local treatment center. He learned that one of the big issues was the shift in how the medications would be doled out to states.

He wants Ada County to partner with a local health care provider, such as Terry Reilly Health Services, to open a site like the one in North Idaho.

He told the Sun that he agrees with public health experts: vaccination is the best way to protect oneself from COVID-19.

But, he said, the reality is that many Idahoans are forgoing vaccinations, and he wants to have an option to save their lives without them adding to the hospital crisis.

The medications are “particularly helpful now," McGeorge said. “If we think how burdened our hospitals are, anything we can do to reduce the likelihood of someone being hospitalized, that's good."

She reiterated that it's a better idea not to get COVID-19 in the first place.

Getting vaccinated, following public health guidelines and wearing masks can prevent a person from ever needing a monoclonal antibody treatment, McGeorge said.

“It's kind of like, if you have a great car with great airbags, it's still better to avoid the accident in the first place," she said. “So the airbags might reduce the likelihood you're going to end up in the hospital, but still, I think we would all agree, better to not get in the accident in the first place — and especially now that the hospitals are so burdened."

Who is administering monoclonal antibodies?

Just as with COVID-19 testing and vaccines, the supply of monoclonal antibodies is unpredictable.

At least for now, Idahoans cannot simply walk into a hospital or infusion site and get treatment. The medication must be ordered by a physician, after a positive COVID-19 test and an evaluation of risk factors for hospitalization.

About 30 medical providers have administered the therapeutic drugs, according to the state. Monoclonal antibody therapeutics have been shipped to these health care providers in the past several weeks, according to federal data. You cannot receive monoclonal antibodies at these centers without a referral from a health care provider. These infusion/injection sites will not take walk-in patients. Contact your health care provider for information.

Ada County: Saint Alphonsus Health System, Boise; St. Luke's Health System, Boise and Meridian; Vibra Hospital, Boise
Bannock County: Portneuf Medical Center, Pocatello
Benewah County: Benewah Community Hospital, St. Maries
Blaine County: St. Luke's Health System, Ketchum
Bonneville County: Eastern Idaho Regional Medical Center, Idaho Falls; Mountain View Hospital, Idaho Falls; Jones Family Medicine, Ammon
Boundary County: Bonners Ferry Family Medicine, Bonners Ferry
Butte County: Lost Rivers Medical Center, Arco
Canyon County: Saint Alphonsus Health System, Nampa; St. Luke's Health System, Nampa
Caribou County: Caribou Medical Center, Soda Springs
Cassia County: Cassia Regional Hospital, Burley
Elmore County: St. Luke's Health System, Mountain Home
Gooding County: North Canyon Medical Center, Gooding
Kootenai County: Heritage Health, Post Falls; Northwest Specialty Hospital, Post Falls
Latah County: Gritman Medical Center, Moscow
Lemhi County: Steele Memorial Medical Center, Salmon
Madison County: Madison Memorial Hospital, Rexburg; Teton Medical Group, Rexburg
Minidoka County: Minidoka Memorial Hospital, Rupert
Nez Perce County: St. Joseph Regional Medical Center, Lewiston
Payette County: St. Luke's Health System, Fruitland
Shoshone County: Shoshone Medical Center, Kellogg
Teton County: Teton Valley Health Care, Driggs
Twin Falls County: St. Luke's Health System, Twin Falls
Valley County: Cascade Medical Center, Cascade; St. Luke's Health System, McCall
Washington County: Weiser Memorial Hospital, Weiser

Idaho Capital Sun is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christine Lords for questions: Follow Idaho Capital Sun on Facebook and Twitter.

FEMA has paid more than $1.9 million for Idaho COVID-19 funerals

The Federal Emergency Management Agency says 624 Idahoans have begun applying for help with funeral costs for loved ones who died of COVID-19.

So far, FEMA has approved 331 of those requests, for a total of $1.9 million in federal aid for COVID-19 funerals, according to a Sept. 20 news release.

The agency has provided more than $1.1 billion in financial assistance to nearly 170,000 people to help cover funeral costs for people who died of causes related to COVID-19 since Jan. 20, 2020, the release said.

There have been more than 2,700 COVID-19-related deaths among Idahoans since the pandemic began, according to data from the Idaho Department of Health and Welfare.

The FEMA funds can go toward a funeral, cremation, casket or urn, burial plot, headstone and other expenses.

For people who lost multiple loved ones to COVID-19, the program provides a maximum of $9,000 per deceased individual, up to a total of $35,500.

Applicants can call the COVID-19 Funeral Assistance Helpline at 844-684-6333 from 7 a.m. to 7 p.m. Mountain Time, Monday through Friday. Return calls from FEMA may come from an unidentified number.

Here are the criteria to be eligible for COVID-19 funeral assistance:

  • For deaths that occurred after May 16, 2020, the death certificate must attribute the death to COVID-19.
  • For deaths that occurred from Jan. 20 to May 16, 2020, if the death certificate doesn't attribute the cause of death to COVID-19, the certificate must be accompanied by a signed statement saying COVID-19 was a cause or contributing cause of death, and explaining how COVID-19 caused or contributed to the death. That statement can come from the original certifier of the death certificate or, in Idaho, from a coroner in the county where the death occurred.

Visit for more information.

Idaho Capital Sun is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christine Lords for questions: Follow Idaho Capital Sun on Facebook and Twitter.

‘We are breaking’: Idaho’s health care workers describe what it’s like going to war against COVID-19

Editor's note: This is the third story in a series from the Idaho Capital Sun on what the Gem State's health care workers are experiencing as they battle the latest surge of coronavirus in Idaho. Visit or to read the first two stories.
A man in cowboy boots and a cowboy hat checked in at Saint Alphonsus Regional Medical Center.

It was the morning of Sept. 16, and Idaho had just hit “crisis standards," a point of last resort for health care. Hospitals had so many patients with COVID-19, the state gave them permission to downgrade medical care for everyone. That could mean discharging patients faster than usual, or it could mean the unthinkable: choosing who gets an intensive care bed or oxygen.

But the hospital was calm, and so was the man in the cowboy hat. He placed his worn Bible on the front desk and leaned in for a temperature check. He wasn't at Saint Al's because he was sick, he told the woman screening him for a visitor pass. He was there to minister to a patient being taken off a ventilator. He picked up his Bible and headed for the elevator.

A few hours later, a few floors up in the ICU, another patient called his family over Zoom. He said what might be his last goodbye, as doctors, nurses and a respiratory therapist got him ready for intubation.

Since the fourth surge began, the Idaho Capital Sun has interviewed dozens of Idaho health care workers about what they've seen on the front lines of the war with COVID-19.

The Sun confirmed their employment but allowed some of them to speak anonymously — so they could speak freely and because the events now happening in Idaho hospitals are so similar as to be virtually interchangeable.

No health care worker revealed any patient's identity or private medical information.

Things are 'different' in the ER, but patients still get care

It was the weekend before Labor Day. As an ICU doctor and a member of Idaho's crisis standards committee, Dr. Rebecca Legg wasn't on vacation. She was waiting for a phone call.

“I've lived with this, now, for a year and a half," Legg said in an interview that weekend. “How are we going to do this?"

Not only was Legg treating COVID-19 patients for Saint Alphonsus Health System, she spent the pandemic immersed in ethical quandaries. She helped to write Idaho's framework for health care providers to use when a catastrophe forces them to make life-or-death choices.

That framework would guide Idaho through “crisis standards of care."

On Labor Day, Legg and the rest of Idaho's 33-member crisis standards committee got the call: Coeur d'Alene's Kootenai Health needed permission to ratchet down the quality of its medical care. It was so overloaded that hospital staff turned a classroom into a medical unit.

With the committee's recommendation, Idaho Health and Welfare Director Dave Jeppesen on Sept. 6 activated crisis standards for North Idaho.

Idaho's largest health system made its own request the following week, and Jeppesen on Sept. 16 expanded “crisis standards" to the entire state. Then, he experienced the crisis firsthand.

“My mom had a stroke Thursday morning, just a few hours after crisis standards of care was activated statewide," Jeppesen said during a press briefing this week. “Not only was it stressful that my mom had a stroke, there was added worry about the availability of health care when she went to the ER."

Jeppesen fought back tears and his voice quavered as he recounted the day.

“Things were different in the ER," he said. “There were other patients receiving care in the waiting room. My mom fell when she had her stroke, and there was a concern that she had broken bones. X-rays were done in a non-traditional X-ray area, with a longer wait than usual. Fortunately, she did not break any bones. Normally, a person in her condition would be held overnight for observation. Because of crisis standards of care, after she was stable, she was discharged later the same day from the ER."

Jeppesen said the emergency room team was “amazing" and “caring, empathetic and positive" even under intense pressure. He said his mother is recovering at home, with family as a de-facto nursing team.

Jeppesen pleaded with Idahoans — repeating words he's used for months. This time, his chin trembled as he spoke:

“We are so lucky to have such talented health care professionals in Idaho. And those same dedicated health care professionals across the state need our help. They need the unvaccinated to please consider choosing to get vaccinated. The vaccines work, they are safe and effective. And they need all of us to please wear a mask indoors and in crowded outdoor spaces."

Idahoans peddle misinformation, people get sick

Idaho's coronavirus cases, hospitalizations and deaths have risen for weeks. The daily body count has been in the double digits for a month. Idaho has now recorded more than 2,700 COVID-19 related deaths — about 490 since Aug. 1 alone.

Still, Idaho's vaccination rate remains stuck at well under half the population, the lowest rate in the U.S.

Interviews with doctors and nurses suggest Idaho is stuck in a perfect storm of distrust that is sending people to their deaths.

The pandemic was a growth opportunity for the cottage industry of health misinformation, including some local doctors, unlicensed practitioners and ideological groups who have spread unsupported claims about COVID-19 and vaccines.

They declare that health authorities who contradict their claims are lying and can't be trusted. So, many Idahoans follow their advice, reject the COVID-19 vaccine and ignore public health advice. And when they catch the coronavirus and end up hospitalized, these Idahoans argue with doctors and nurses, even as their organs fail and they can't breathe.

One of Legg's recent patients was an older woman with high blood pressure, diabetes and a suppressed immune system. She refused to go on a ventilator because she was convinced the hospital “would vaccinate her against her will," Legg said. The woman survived, but even as she left the hospital, she kept a tight grip on her belief that the vaccine “would be what killed her," Legg said.

Another patient, a middle-aged man, “just really fought against everything that we offered" to help him, Legg said.

He refused to be intubated until his heart was about to stop.

“Do you know the stress around trying to intubate a patient who was that desperate?" Legg said.

After he was on the ventilator, his family took up his battle.

“His family was just insistent that we were hurting him. And that what was going to save him was ivermectin," Legg said. “They threatened litigation against us. Ultimately, we allowed them to get a prescription for ivermectin and bring it in. And, of course, he died shortly afterwards anyway."

Dr. Jason Slade, a hospitalist at St. Luke's Nampa, recently had a patient for weeks who said he wasn't vaccinated because he was Christian and trusted God.

“God sends us a lot of miracles and things to use to deal with hard times. This may be a miracle God sent us," Slade said to the patient, who was unconvinced.

The man's health deteriorated. His lungs thickened and built up scar tissue. Oxygen couldn't make it through anymore. The damage probably would not heal, Slade told the man, who demanded the doctor talk to one of his family members about treatments.

The family member didn't know anything about the medications doctors were giving the man. Instead, she insisted they use “certain therapies" that don't work, Slade said.

When he asked what her role was in health care, she told him, “My role is a mom, and I've done my research, and I've talked with other medical professionals, and I know about your protocols, and I don't approve of them."

A few days later, the man's oxygen levels plummeted. Slade invited a family member to come to the hospital for what was likely to be a final visit.

“The whole family came down," Slade said. “I went out to explain to them (what was happening), and it was an unpleasant interaction. They had lots of accusations, demands."

The man eventually decided to go home with hospice care and died the day he went home, Slade said.

Slade, Legg and other health care providers are working overtime and witnessing death on a regular basis.

St. Luke's Health System averaged four COVID-19 deaths per day this month alone, St. Luke's Chief Physician Executive Dr. Jim Souza said Tuesday.

When patients and their families distrust health care workers, it adds to the emotional toll of these casualties.

“The health care system and health care workers, for all of our flaws — and we certainly have them — we still are here to help. We want you to live through an illness if you get it, we want you to survive," Legg said. “We just want to help. That's why we all went to medical school, that's why nurses went to nursing school."

'I wish everyone could see. … It's not a gentle death'

The front lines of the COVID-19 war are hidden from view. The worst parts of the pandemic are happening inside the hospital walls.

The Idaho doctors and practitioners who are fomenting distrust in public health do not work with COVID-19 patients in hospitals.

And the public cannot see what's happening because of privacy laws and visitor restrictions.

“People, when they hear the word epidemic or pandemic, I think in their mind they think of something like the bubonic plague. 'Bring out your dead!' and people dying in the street," Slade said. “We have evolved in our society that the level of (suffering in) this pandemic has been able to be suppressed. You aren't seeing this up close and personal because it concentrates in the hospitals. People that you personally know, they show up at the hospital, along with everyone else in the neighborhood. (And) we're at a spot where we're running out of physical space."

The Sun visited Saint Alphonsus hospital in Boise the day Idaho declared crisis standards. Health care workers expressed relief that journalists were inside the hospital.

Until recently, Idaho health care workers, families of COVID-19 patients and COVID-19 survivors were the only ones who could bear witness — and, often, people would accuse them of lying.

“I want them to come and see how sick these people are," said one local nurse. “For the patients that don't want to be intubated and we watch them decline, it is like a slow descent into madness."

The high-flow oxygen masks feel like “sticking your face out of a car window," the nurse said, and it makes it hard to eat. So the patients lose weight and “just shrink into nothing," she said.

“I wish everyone could see. I really think that if some 40-year-old guys had to come help me clean up the 40-year-old patients who are incontinent … and pooping themselves," that might persuade them to get vaccinated, she said.

“It's not a nice way to die. It's not a gentle death," she said. “It's not a good death. It's a lonely death. … But at this point, this is what people are choosing."

'I wish that I could tell those patients' families … they mattered'

The lack of space is one reason Idaho moved into crisis standards.

Saint Alphonsus in Boise recently turned a physical therapy gym into a COVID-19 overflow unit.

St. Luke's and other hospitals are doing ER triage in the waiting room.

I've got three patients up in the (medical-surgical) unit" who are on maximum oxygen flow, Slade told the Sun in an early September interview. “They look like they're tired and they're failing. We're full. We had to kind of Tetris who can go into a lower level of care."

The doctors and nurses came up with a plan. They moved patients to the ICU, one at a time. “We intubated three people that night," he said. “The patient that I intubated last night, the only reason she had a bed and ventilator available was because the patient who had been in that bed, on that ventilator, died."

I don't think people realize that we are breaking. The whole system is on edge.

– Dr. Jason Slade, St. Luke's Nampa

One nurse in a Magic Valley hospital told the Sun that most shifts now end in tears. Even when she's away from work, she spends her time worrying about it.

Frontline worker in crisis? There is help

Idaho launched a dedicated, free hotline last year for frontline workers. It offers 24/7 crisis counseling and helps callers access short-term and longer term mental health care. Call 866-536-0239.

Another nurse who works in a local COVID-19 unit said the patients she cares for now “are incredibly, incredibly sick."

In normal times, the patients on her floor would be sent to the ICU, because that's where they really belong. But that's not always an option now.

“At the end of the day, if I've charted most everything, and they're alive, I'm happy. But nobody gets a bath every day," she said.

Some of the patients come to her floor after an ICU stay.

“They've got tubes in every orifice, literally every orifice. Some of these people are so sick and so weak, it is basic life-giving cares we are giving, it is not cares that we would like to give," she said. “These are brutal shifts."

Nurse managers have jumped in to help, which is rare, she said.

Her team starts each shifts looking for patients who might be ready for discharge, she said. Then, someone tells them the ER has dozens of people waiting, there are only three beds left in the hospital, “and the other hospitals are on divert. It's terrifying," she said. “How? How are we supposed to keep doing this?"

The nurse has lost many “really special" patients to COVID-19 over the past year and a half, she said. One sticks with her, an older man last year, who was worried about his dog. Would the dog's last memory of him be getting rolled into an ambulance? What would happen to his dog when he died?

She didn't know.

“I wish that I could tell those patients' families how much I've loved their family members, but it's HIPAA and all that," she said. “We get to write little cards and stuff. But how do you tell them almost a year later that you haven't forgotten their loved one, and that they mattered?"

What can you do to help?

Every health care worker the Sun interviewed said getting a COVID-19 vaccine is key. (And don't forget a flu shot.)

For people already vaccinated, there are other ways to help:

  • If you have a medical emergency, go to the emergency room. The ER staff will help you. Don't be surprised if there is a long wait. Try to be patient and cooperative. “Don't yell. Don't throw things. Understand the overall situation — that things are not normal now," one nurse said.
  • If you're already vaccinated, share your story with people close to you who aren't. Explain why you chose to get the vaccine, and what your experience has been. Listen to their concerns. Encourage them to talk with a trusted, qualified medical professional about the vaccine.
  • Continue to wear masks, especially in public places.
  • Avoid crowded indoor spaces. Avoid large gatherings.
  • Get tested frequently for COVID-19, especially before spending time with at-risk friends and family members. If you can, buy over-the-counter rapid tests to use at home.

Idaho Capital Sun is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christine Lords for questions: Follow Idaho Capital Sun on Facebook and Twitter.

'We’re seeing the de-evolution of humanity': Idaho’s largest hospital CEO on Covid denial

The day before Idaho activated “crisis standards of care" statewide, St. Luke's Health System made a request for that last-resort declaration. It had no other choice.
The state's crisis standards activation committee was called to meet on Wednesday, Sept. 15, to consider the request. The process had to move quickly. St. Luke's CEO Chris Roth presented to the committee by videoconference, from his daughter's bedroom.

“It was a memorable place to be, during a really sobering call," Roth told the Idaho Capital Sun.

'We’re seeing the de-evolution of humanity': Idaho’s largest hospital CEO on Covid denial

That day, St. Luke's had a record 281 COVID-19 patients in its hospitals — occupying more than half of its 475 staffed adult hospital beds.

The hospital system had already opened 93 beds in overflow areas. It ran out of physical beds “and would be treating patients on stretchers until the additional beds they have ordered arrive," the Idaho Department of Health and Welfare's declaration said. St. Luke's told the state's crisis standards committee that 58 of its 71 ICU patients had COVID-19, that it was starting to use pediatric ventilators for adult patients, and that it had to cancel surgeries such as “removal of low risk cancers, fractures with pain and hernia repairs," the declaration said.

Even then, St. Luke's couldn't keep up with the influx of patients, and its projections for the coming weeks were dire — reaching a point where it would have to choose between patients.

Roth talked with the Sun in a video interview Friday, the day after crisis standards were activated statewide. He talked about the health system's vaccine requirement, the disinformation that fuels the surge of COVID-19, and more.

We hired nearly 300 people this last Monday. We have another 100 next Monday, and another 100 the Monday after.

– Chris Roth, CEO of St. Luke's Health System, in an interview Friday, Sept. 17, 2021

This interview is edited for length and clarity.

Idaho Capital Sun: How are you feeling about this surge, and the move to crisis standards?

Chris Roth: It's been a surreal 20 months. I stepped into this role in February of 2020. Lots of ups and downs, for sure. But I'm very proud of our organization. We're focused. I know we will get through this. We have an amazing team. I have a great support system — my kids, wife, a board that's behind me.

I'm sad, and I'm concerned for the people who are actually doing the work. I have a job, and I'm doing everything I can. But I'm not on the front lines. There's a helpless feeling — and our leaders feel this, and our board feels this — like, what more can we do to help the people who are providing care? There's a helplessness there. But there's also optimism, and there are a lot of bright spots, every day, just got to look for them.

Idaho Capital Sun: What do you think it's going to take for more Idahoans to take the risk of COVID-19 seriously?

Roth: What we're seeing in our community, in our society, is that too many are putting the individual before the community. I think one of two things is going to have to happen: The suffering is going to have to get more personal and closer to individuals — which is the worst case scenario — or, you know, I was talking with (Idaho House Speaker Scott Bedke, R-Oakley) last week, and he toured our ICU. And after that, he said he was able to convince, I think he said, five people to get vaccinated, which is awesome. It's incredible. So the other opportunity we have is that — individual communications to convince the people who are hesitant or skeptical, for whatever reason, to get vaccinated.

If people weren't scared to hear the news yesterday (about the move into crisis standards), they should be. At the same time, we don't want to communicate to the public that they shouldn't come in to receive care if they need it.

We need people to come in if they're sick, and we'll take care of them. Care may be delayed, probably will be delayed, but we can care for people today, and we will continue to do that.

Idaho Capital Sun: How are your employees doing, with the move to crisis standards and possibly making live-or-death choices for patients?

Roth: We're deeply concerned about our frontline caregivers, and they are just going through hell. Every day. And then they go out to the community, and it's business as usual — rodeos, fairs, football games, debates in the school boards.

I made the mistake, a couple weeks ago, of listening to all six and a half hours of the West Ada School District school board meeting, and (two St. Luke's chief physicians) were kind of sharing a perspective, and they literally got laughed at by some of the audience when they were talking about what's going on in the hospitals.

It's like we're seeing the de-evolution of humanity, right in front of our eyes.

Idaho Capital Sun: Where are you right now, on the vaccine requirement for staff?

Roth: We had a deadline of Sept. 1 for the first vaccination. That didn't mean that we were firing a bunch of people on Sept. 2. There's a whole process that plays out. We've been very, very pleased with compliance with our policy. Now, when I say “compliance," that's either getting the vaccine or having a valid exemption. And as of this morning, we are just above 97%.

We've hired 802 individuals over the past 60 days. And when we hire those people, they need to be compliant with the vaccine as well. Maybe some were vaccinated at St. Luke's but many (were vaccinated elsewhere), so we have to get those records. It takes time. We think that 97% is probably closer to 99%, a little higher than 99%.

I think we will have somewhere in the neighborhood of 150 to 200 individuals who are just going to refuse. That's out of 17,000 people.

– Chris Roth, CEO of St. Luke's Health System, on the staff's compliance with COVID-19 vaccine requirements

We made the decision yesterday, and we're communicating it today to our employees, that we are going to extend our timeline. We've always said we're going to put safety first. And when we announced the vaccine requirement, that was July 8, I believe. Delta was starting, but nothing like what we've seen (since then), and we did not anticipate we would be in crisis standards at this time.

We will take extra precautions to protect that (unvaccinated) staff. We're going to test them. We've got all the masking and (other precautions), but we're not going to initiate terminations of individuals, while we're in crisis standards. It's just not the responsible thing to do. But we are not backing off of the vaccine requirement, we're just extending the timeline.

The most pushback and criticism has come from people who don't even work at St Luke's.

– Chris Roth, CEO of St. Luke's Health System, on reaction to the system's COVID-19 vaccine requirement

It's difficult to say, “Look, we're not going to do surgeries for low-grade cancer and tumor removal," and at the same time, asking people to leave our organization. And not everybody's a frontline caregiver (who isn't yet vaccinated), we get that, but we want to treat everybody the same.

So that's where we are right now. Our progress has been phenomenal, and the support (within) the organization has been incredible.

Idaho Capital Sun: Did St. Luke's request crisis standards of care to keep from having to enforce the vaccine rule?

Roth: Absolutely not. But it's a fair question. I've thought about that myself, like, 'Oh, isn't that convenient.'

The driver for crisis standards was … our standard of care is eroding, and crisis standards enable our clinicians to make real time decisions (in an ethical framework). We have been seeing increasing levels of anxiety and concern with our frontline licensed caregivers. Their license is on the line, and they need to practice according to that license, and they have been on the edge, doing things that are not typical of their license and are not typical of our normal policies and practices.

So that's why we implemented crisis standards. The fact that we have a fraction of people who are still not compliant … we made the decision (to give an extension on compliance) because we need the people right now. But it's a fair question, and I'm sure the conspiracy theorists will say, “Well, there you go."

Sadly, we've had individuals who have been used by other groups, or other causes, like the 'health freedom' group. We've had some of our own people who have been put in front of the camera, and frankly they're just getting used for somebody else's cause, and that's unfortunate.

Idaho Capital Sun: Are the unvaccinated employees in areas where you have critical staffing shortages, like ICU nurses?

Roth: Our physicians are at 100%. Then you get to nurses and respiratory therapists and pharmacists, it's (also very high). Then you get to areas where we've struggled — environmental services, laundry, security, people who are answering the phone, scheduling, registration. Many of those are in contact with the public, and patients, but we see less compliance in those areas.

I've been asked, “Well, can you treat the two groups differently?" And what we've said from the beginning is that, you know, our frontline health care workers already feel like they've been carrying the burden of the pandemic for 20 months. And we don't want to send a message to them that, “Oh, this group of people are not part of the same team, or don't have the obligation." It's critically important that we say: we are a team. We either provide direct patient care, or we support those who do, and we're not going to bifurcate our organization that way.

Idaho Capital Sun: Do you think state and local government could do anything to help?

Roth: If we could rewind the clock, and rewind time, and make different decisions, I'm sure a lot of us would — maybe the governor, local leaders, others. I've been critical of state and public health district leadership, particularly in 2020.

But we're here where we are today. We can't ignore the politics that are going on in the community.

I'll start with the governor. I think he's doing a really good job, given the circumstances, and he has stood behind the employer's right to make decisions for their workforce. He stood behind government not intervening in things that are more local. Now, that cuts both ways, I get it. But if you look at who's in line to run against him … I think he needs to stay the course, in that way. It's almost like, what's the worst potential outcome?

I wish the health districts would go back to where we were last year. They had criteria, they had community spread criteria, they counseled people on group sizes and masks. I think that health districts have so many levers they can pull that they're not pulling, and I think that if anything's going to change, it's going to be at that level, not at the state level.

I also believe that the state and the Idaho State Board of Education could lean in further with the universities and high schools. I think the university presidents in particular are on an island, making big decisions about things like masking in schools and football games. I'm really concerned about the weight on principals, superintendents, university presidents, and I think they need more cover from the state. I don't know exactly what that looks like, but they need more support, because they're being left on an island right now.

Idaho Capital Sun: It seems like many Idahoans don't know whom to trust right now. Some of them are, unfortunately, looking to ideological groups and even some health care providers who are misleading them. What are your thoughts?

Roth: I think that the people who are intentionally spreading misinformation, for their own personal gain, are going to be held accountable. It's a matter of time. And that's probably all I have to say about those types of individuals.

I also think that we're reminded that elections matter. They matter a lot, and local elections matter.

Everything's political right now. But these health districts, particularly Central District Health, it's all about politics and not about public health. And, you know, we'll see what happens in the next election. People are going to have to choose whether and how that changes.

But I do believe that people spreading misinformation, particularly those who are licensed medical professionals who have taken an oath, will be held accountable.

Idaho Capital Sun: Do you know they will be held accountable? Or do you just hope so?

Roth: I hope they will be. But I would put money on it that they will be at some point. And it's a national problem, it's just not an Idaho problem. We have a very fragmented national system of boards of medicine and boards of nursing and others. That's been a problem for years. But I think that those individuals are going to get rooted out somehow, I hope.

Idaho Capital Sun is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christine Lords for questions: Follow Idaho Capital Sun on Facebook and Twitter.

A misleading claim about Idaho’s hospital crisis has gone viral: The state is not under a ‘universal DNR’

A claim that everyone in Idaho is now under a “do-not-resuscitate" order — that they won't be revived if their heart stops in the hospital — has gone viral on social media. But it's not true.
The state entered “crisis standards of care" last week, giving Idaho hospitals, nurses and doctors an ethical framework to help them make decisions about using scarce resources during the COVID-19 surge.

People misinterpreted one piece of that guidance. Now, the misinformation is spreading. Prominent social media accounts have repeated it on Twitter, TikTok and Facebook.

Dr. Frank Johnson, St. Luke's Health System chief medical officer, worries that it might keep people from going to the hospital.

Johnson chairs the St. Luke's crisis standards committee.

“We don't want people who are in need of emergent care to stay away from the hospital. If you're having chest pain (or) symptoms of a heart attack or stroke, my goodness, come to the hospital," he said.

St. Luke's Health System on Saturday addressed the claim on its own social media accounts.

“To be clear, there is no 'universal DNR' at St. Luke's," the health system said on Twitter. “The state of Idaho includes a reference to 'universal DNR' in their Crisis Standards of Care Activation plan. The state's plan contemplates and provides guidance on a range of issues that provider organizations may or may not have a need to implement. St. Luke's does not include this element in our Crisis Standards of Care plan and our internal CSC steering committee has recommended against having such a policy. We understand area providers are taking a similar approach."

As with most misinformation, there is a grain of truth

The Idaho crisis standards of care plan includes in its guidance a section about what to do if, for example, there's a ventilator shortage. One part of that guidance addresses whether to try reviving adults whose hearts have stopped, even if they're not already on a ventilator.

Adult patients hospitalized during a public health emergency, when crisis standards of care have been declared (and a hospital is using the mechanical ventilation allocation framework due to demand for ventilators exceeding supply), should receive aggressive interventions; however, they should receive NO attempts at resuscitation (compressions, shocks or intubation if not yet intubated) in the event of cardiac arrest. The likelihood of survival after a cardiac arrest is extremely low for adult patients. As well, resuscitation poses significant risk to healthcare workers due to aerosolization of body fluids and uses large quantities of scarce resources such as staff time, personal protective equipment, and lifesaving medications, with minimal opportunity for benefit. This universal DNR order does not apply to pediatric patients; however, pediatric patients requiring a ventilator after resuscitation would enter the ventilator triage protocol after resuscitation, just like other patients needing ventilator access.

– Patient Care Strategies for Scarce Resource Situations guide for Idaho crisis standards of care

So in theory, it is possible that a person who goes into cardiac arrest could be allowed to die. But first, three things must happen:

  1. Crisis standards of care must be declared. That happened statewide on Thursday.
  2. Hospitals operating under crisis standards would have to include this “universal DNR" in their own plans. St. Luke's, which is Idaho's largest hospital system, does not currently have a universal DNR in its plan to deal with the COVID-19 crisis.
  3. And this is the “important part," says Johnson: A hospital must not have enough ventilators. The shortage must be significant enough for a hospital to be forced into using the “mechanical ventilation allocation framework." Johnson said that applies to “nobody I know in the state" at this point. St. Luke's still has enough ventilators, he said. Earlier this week, it was using 77 of 101 in its supply and recently placed orders for 20 more to arrive in the next couple of weeks, he said. “We're limited in staff, for sure, we're limited in space, for sure, but ventilators, we still have enough," he said.

It's also important to note that the state plan is a framework. It is meant to help hospitals make an impossible choice: decide who gets life-saving care when they don't have enough for everyone. It is not an order for hospitals or medical workers to withhold medical care when they can adequately provide it.

Johnson notes that the Idaho crisis standards plan doesn't apply to just this crisis. It is a framework developed for any overwhelming medical crisis — whether that's a pandemic, a natural disaster or a sudden mass casualty event.

St. Luke's and other hospitals are digging out older ventilators and requesting more to meet the demand from a growing number of COVID-19 patients. But they're not at a point where they need to stop doing CPR on patients, Johnson said. He says a “universal DNR" is more likely in an immediate crisis scenario.

“You've got Hurricane Katrina, all the power's out, the hospitals are flooded. … You have 30 people who need a ventilator in the ICU, and you only have 20 (ventilators)," he said.

Idaho is in crisis standards, which is very serious. And it was preventable; almost all hospitalized COVID-19 patients are unvaccinated.

Crisis standards could mean some people won't get life-saving care. It could mean that health care providers will have to decide which patient is most likely to be saved by one ventilator. But, at least for now, it doesn't mean every adult is marked “DNR."

Johnson provided the Sun with a document St. Luke's prepared Friday. It addresses DNRs and other questions about how St. Luke's is managing crisis standards.

St. Luke's crisis standards FAQ

Idaho Capital Sun is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christine Lords for questions: Follow Idaho Capital Sun on Facebook and Twitter.

Idaho’s exhausted health care workers describe what it’s like going to war against COVID-19

(Editor's note: This is the second story in a series from the Idaho Capital Sun on what the Gem State's health care workers are experiencing as they battle the latest surge of coronavirus in Idaho. Visit to read the first story.)

The morning after a middle-aged man with COVID-19 died in a Treasure Valley emergency room last month, a health care worker who'd been there for his death couldn't bring herself to go back into the hospital.

This article was originally published at Idaho Capital Sun

She sat in her car that morning, trying to process what happened. She recorded herself thinking out loud.

“I've seen people die in the ER," she said in the recording. “Things like that stay with me. I remember those people, I can see them very clearly."

This felt different, she said. Maybe it was because health care workers believed they'd made it through the worst of the pandemic — only for COVID-19 to return, killing patients who chose not to get a vaccine. Or maybe it was because of the man's daughter, whose cries had echoed down the hallway.

“I just can't stop thinking about that girl. I just can't. I see her face, and her puffy eyes," she said. “It was so sad. It was so, so sad. I just think, my God, it's just a shot … and this could've been avoided, right? It just broke my heart, and I can't stop thinking about that girl, I can't stop thinking about her."

The pandemic is leaving scars on Idahoans. For health care workers, the scar thickens with every 12-hour shift they spend trying to save people from COVID-19.

The Idaho Capital Sun has interviewed more than a dozen Idaho health care workers about what they've seen during this fourth surge, on the front lines of the war with COVID-19.

The Sun confirmed their employment but allowed some of them to speak anonymously — so they could speak freely and because the events now happening in Idaho hospitals are so similar as to be virtually interchangeable.

No health care worker revealed any patient's identity or private medical information.

'I'm sorry about the position that they found themselves in'

Health care workers across the state are fighting an internal battle, on top of their fight to keep people alive and healthy.

Dr. Patrick “Paddy" Kinney, a family physician in rural McCall, is one of them.

He is distraught when his patients choose not to be vaccinated against a fast-spreading virus.

He is distraught when those patients later get COVID-19.

And he's distraught that, when they come into the emergency room, they need a bed in “an overburdened system that's about ready to topple," he said in an interview last week.

For the past 18 months, Kinney said, he's talked with his patients about COVID-19. Tried to answer their questions. Tried to assuage their concerns. Urged them to get vaccinated.

“But then, I'm also the guy that when they don't make that decision (to get vaccinated) and they come in super sick to the ER, here I am again," he said.

“A lot of them apologize, like, 'I'm so sorry that I didn't listen to you.' And I don't want them to say that they're sorry. I'm sorry that they're sorry," he said. “I'm sorry about the position that they found themselves in. Clearly, I think that they're paying the price for that decision. At the same time, I'm struggling with (whether) I could have done a better job explaining the risks and benefits of the vaccine to you."

Kinney said it's “really hard when I've got one of my patients in the ER … and they cannot even speak in full sentences because they're short of breath, and they're hacking and coughing, and they look scared and sick."

Many health care workers told the Sun they struggle with the same mix of emotions. Vaccines are very effective at keeping people out of the hospital from COVID-19. Yet, many patients show up unvaccinated.

The Idaho Department of Health and Welfare's statistics show that 91.6% of all hospitalizations for COVID-19 in Idaho since May 15 are among people who aren't fully vaccinated. Hospital administrators and frontline health care workers have confirmed for months that almost everyone admitted to a hospital with COVID-19 is unvaccinated.

Health care workers still take care of everyone, regardless of vaccination status. Not only because they have to, but because they got into medicine, nursing and therapy to help people.

“I'm doing so at the expense of everyone else," Kinney said. “When there's not enough rooms, when there's not enough nurses, when everybody's exhausted, when the hospitals are at 105% capacity, when there's three ICU beds left in the state, that is hard."

His patients sometimes wait six to eight hours in the McCall emergency room for a bed to open up in Boise, where they need to go, he said. When the Treasure Valley hospitals are full, the patients are sent to Twin Falls.

But even those larger hospitals around the state are at a breaking point. When they're full, they can no longer take patients from small hospitals like St. Luke's McCall.

“I think it was Friday night or Saturday night, I had a bad COVID patient who needed to be admitted — again, 16 liters of oxygen and very sick, and he was ready to go at 9 p.m.," Kinney said. “Now, I knew that he needed to be admitted, and the hospitalist down in Boise agreed that he needed to be admitted. There was not a bed available for him until 2 a.m."

Kinney told the man he would keep doing his best to take care of him in the ER for the next five hours.

Frontline worker in crisis? There is help

Idaho launched a dedicated, free hotline last year for frontline workers. It offers 24/7 crisis counseling and helps callers access short-term and longer term mental health care. Call 866-536-0239.

“What's going to happen at 2 a.m.?" the man asked.

Kinney had to be honest. There's one reason a bed opens up at 2 a.m., he said.

“There's a chance that your bed is going to be made available by somebody else dying," Kinney said.

The patient's face was covered by an oxygen mask, but Kinney could see the man's eyes. He was terrified.

The patient did get that bed in Boise at 2 a.m. But he declined rapidly. He, too, recently died, “making room for someone else," Kinney said.

All hands on deck in Idaho hospitals

Idaho this week turned a grim corner in the pandemic.

The state activated “crisis standards of care" for North Idaho — a decision that will allow overwhelmed hospitals to triage patients and ration medical care to save as many lives as possible.

That decision will have a ripple effect throughout the state and the region, where hospitals and especially intensive care units are hanging on by a thread.

Health systems have begun to pull in more doctors and nurses to work in the hospital.

Kinney usually has 1,200 to 1,300 patients under his family practice clinic's wing at any given time. He's been the family doctor for some of those Idahoans since he joined St. Luke's McCall in 2014.

“I managed their pregnancies, I delivered their babies … acted as their pediatrician and took care of multiple generations," Kinney said.

He sees his regular patients in his clinic three days a week, takes on-call shifts at the hospital and works in the ER three or four times a month.

Now, the surge is taking him away from his usual patients.

“I'm going to be spending about 80% of my practice over in the ER," he said.

For now, St. Luke's McCall can take care of everyone who comes through the ER doors, Kinney said. But if Idaho enters statewide crisis standards, that may not still be true.

“The game changes a little bit, because at that point we're admitting that we can't care for everybody in the way that we want to," he said.

Kinney is tired.

He keeps “wondering and trying to figure out why my patients disdain and refuse my advice, in just this one particular area, where they trusted me and in all the other areas of their care," he said.

“We just don't understand why people have trusted us for years, and they've gone through all manner of uncomfortable things on our recommendation. Right? Like every 10 years, they've agreed to letting us put a 6-foot camera up their butt for a colonoscopy," he said. “Every year or three years or five years … they'll get up in the stirrups, get a cold metal speculum put in their vagina for a Pap smear. And, you know, get a flu shot and get a pneumonia shot, get a shingles shot."

Patients take medications their doctors prescribe to them, even when those medications might have side effects.

“They're willing to accept it because they have trusted us (to know) that these things are worth it, and that it's in their best interest," Kinney said.

“And yet in this, it's like you just say the words 'COVID vaccine,' and their faces change, their eyes glaze over," he said. “They somehow feel like they've got better information than we do. And I don't understand it, I really don't. I don't get it."

'They're making the choice for everybody, and we're all living with that choice'

People have always been hospitalized for reasons within their control, to various degrees. Drunk driving. Riding a motorcycle without a helmet. Smoking-related diseases. Untreated diabetes.

The difference now is that health care workers are hearing patients make choices based on disinformation, some of that propagated by doctors in the community.

“Every day in my office, I see patients who haven't been vaccinated, and I hear an incredibly wide spectrum of reasons," a Treasure Valley internal medicine doctor told the Sun in an interview last week. “Today in my office, I had only two of my patients who had not been vaccinated, and neither of them was in any way willing to consider it."

The doctor said one of his patients is young and works in local health care.

“I've been trying to convince him since December to get a vaccine. His mom had been hospitalized with COVID," the doctor said. “And then he got hospitalized this weekend. He told the hospitalist that he'd taken care of patients in the hospital who had been injured by the vaccine, which is ridiculous. … How do you get through to somebody like that?"

One of the spirit-crushing pieces of this surge is that 2021 began with “so much optimism and excitement because we had this vaccine," he said. “And it worked better than anyone dreamed that it might. And then there were two of them! And patients, they were clamoring for them."

But in early April, the phones stopped ringing. Idaho had arrived at a wall of vaccine hesitancy.

“Nobody taught us that in medical school. 'One day we're going to have this disease that's going to overwhelm the hospitals, burn out all our health care workers, and it's going to be preventable.' … Now, there's not much cause for optimism."

His most optimistic thought now is that Idaho will reach herd immunity “by a bigger proportion of natural infection," but that eventuality will take countless lives and healthy bodies with it.

“I tell patients in the office, this is not a good time to have a heart attack or a stroke or get in a car accident or get your appendix removed," he said. “But honestly, I don't think people are concerned. … I do not see people thinking outside the scope of their individual bubble, that's probably the (hardest realization)."

The doctor has been told to prepare to go back into the hospital to help with the surge, he said.

That means he'll be away from his patients, most of whom have chronic diseases.

For now, he is writing orders for them to get monoclonal antibody treatments, he said. But those must be given soon after infection to work, and there was a four to five day wait last week, he said.

He hopes those infusions will keep patients out of the overwhelmed hospitals. But he wishes there was no need to give the infusions in the first place.

“I think the data for it is not the greatest," he said of the infusions. “It's not as good as vaccination by like a factor of 1,000."

“We're still in a pandemic, but we're now in a pandemic of a preventable illness," he said. “We're making a choice as a society to live with this now, and we didn't have to."

But not everyone is involved in that decision, because those who are unvaccinated and get hospitalized can crowd out others who got the vaccine, he noted.

“They're making the choice for everybody, and we're all living with that choice. It's not an individual choice."

Editor's note: This story was updated Wednesday morning to include the recent death of Dr. Paddy Kinney's patient.

-- --

What can you do to help?

Every health care worker the Sun interviewed said getting a COVID-19 vaccine is key. (And don't forget a flu shot.)

People aren't being hospitalized en masse for complications of a COVID-19 vaccine, they said. People are being hospitalized from complications of not getting vaccinated: They caught a virus their body hadn't seen before, and their immune system didn't know how to fight it.

For people already vaccinated, there are other ways to help, they said.

  • If you're already vaccinated, share your story with people close to you. Explain why you chose to get the vaccine, and what your experience has been. “The number one thing that can convince the vaccine-hesitant to ultimately get vaccinated is first-person acquaintances that can give their anecdotal stories about how they got vaccinated," said Dr. Patrick “Paddy" Kinney. “(That is) more successful than any kind of doctor (recommendation). So, I would highly encourage that. These one-on-one conversations with people are very important."
  • Continue to wear masks, especially in public places. “It still holds true that we have decreased infections with masks," said Dr. Allison Gauthier, who works in St. Luke's emergency rooms. “Whether you think masks decrease COVID, they definitely decrease RSV and flu, because we had, like, no infections last year."
  • Get tested frequently for COVID-19, especially before spending time with at-risk family members. If you can, buy some over-the-counter rapid tests to use at home.
  • If you have a medical emergency, go to the emergency room. Don't be surprised if there is a long wait. Try to be patient and cooperative. “Don't yell. Don't throw things. Understand the overall situation — that things are not normal now," one nurse said.

Idaho Capital Sun is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Idaho Capital Sun maintains editorial independence. Contact Editor Christine Lords for questions: Follow Idaho Capital Sun on Facebook and Twitter.